Workshop on Using Social and Behavioural Insights to Support Risk Communications in the Context of Emergencies in the Western Pacific Region, Manila, Philippines, 11-12 April 2024: meeting report

11−12 April 2024 Manila, Philippines (hybrid) Meeting Report WORKSHOP ON USING SOCIAL AND BEHAVIOURAL INSIGHTS TO SUPPORT RISK COMMUNICATIONS IN THE CONTEXT OF EMERGENCIES IN THE WESTERN PACIFIC REGION 1 WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC RS/2024/GE/01(PHL/hybrid) English only MEETING REPORT WORKSHOP ON USING SOCIAL AND BEHAVIOURAL INSIGHTS TO SUPPORT RISK COMMUNICATIONS IN THE CONTEXT OF EMERGENCIES IN THE WESTERN PACIFIC REGION Convened by: WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC Manila, Philippines (hybrid) 11−12 April 2024 Not for sale Printed and distributed by: World Health Organization Regional Office for the Western Pacific Manila, Philippines January 2025 2 NOTE The views expressed in this report are those of the participants of the Workshop on Using Social and Behavioural Insights to Support Risk Communications in the Context of Emergencies in the Western Pacific Region and do not necessarily reflect the policies of the conveners. This report has been prepared by the World Health Organization Regional Office for the Western Pacific for Member States in the Region and for those who participated in the Workshop on Using Social and Behavioural Insights to Support Risk Communications in the Context of Emergencies in the Western Pacific Region in Manila, the Philippines from 11 to 12 April 2024. 3 CONTENTS SUMMARY ........................................................................................................................................................ 4 1. INTRODUCTION .......................................................................................................................................... 5 1.1 Meeting organization ..................................................................................................................................... 5 1.2 Meeting objectives ......................................................................................................................................... 5 2. PROCEEDINGS ............................................................................................................................................. 5 2.1 Opening ceremony ......................................................................................................................................... 5 2.2 Plenary 1: Overview of WHO’s work using behavioural science to strengthen preparedness and response to health emergencies ........................................................................................................................................... 6 2.3 Plenary 2: Introduction of principles for using evidence in health emergency preparedness and response and applying the “Define, Diagnose, Design, Implement and Evaluate” approach ............................................ 6 2.4 Plenary 3: Country presentations and discussions on behavioural insights to support risk communication . 6 2.5 Plenary 4: Collecting and using evidence for behavioural insights to inform effective risk communication and health emergency management ..................................................................................................................... 6 2.6 Plenary 5: Country planning and support for collecting and using behavioural insights for impactful risk communication and health emergency management ........................................................................................... 7 3. CONCLUSIONS AND RECOMMENDATIONS ......................................................................................... 8 3.1 Conclusions .................................................................................................................................................... 8 3.2 Recommendations .......................................................................................................................................... 8 3.2.1 Recommendations for Member States .................................................................................................... 8 3.2.2 Recommendations for WHO ................................................................................................................... 9 ANNEX 1. LIST OF PARTICIPANTS ............................................................................................................ 10 ANNEX 2. PROGRAMME OF ACTIVITIES ................................................................................................. 13 Attitude to health / Behavior and behavior mechanisms / Communication / Disaster planning / Emergencies / Public health / Social sciences - organization and administration / Risk reduction behavior 4 SUMMARY Communication for Health (C4H) is an approach that leverages the power of strategic communication as a tool for creating health impact. In October 2023, Member States of the World Health Organization (WHO) Western Pacific Region endorsed the Regional Action Framework on Communication for Health during the seventy-fourth session of the WHO Regional Committee. The Framework highlights the need for evidence-based communication actions supported by social and behavioural insights. In the emergency context, it is essential to communicate risks to the public. Having evidence of drivers and barriers for target audiences of the uptake of public health advice is essential for the design of risk communication and community engagement (RCCE) interventions. RCCE is a core capacity required under the International Health Regulations (IHR) (2005) and a critical area contributing to multiple domains of the Asia Pacific Health Security Action Framework (APHSAF). This Framework, endorsed by Member States of the Western Pacific Region in 2023, is designed to engage multisectoral actions in health security and to reflect the complex nature of current and future public health emergencies. The workshop on Using Social and Behavioural Insights to Support Risk Communications in the Context of Emergencies in the Western Pacific Region was held in Manila, Philippines, from 11 to 12 April 2024. It was attended by 13 participants from seven Member States. The overarching goal of the workshop was to increase the capacity of Member States and WHO country offices to apply social and behavioural insights to strengthen and scale up application of the C4H approach in the context of emergencies. This workshop addressed gaps in knowledge and challenges in applying social and behavioural science to prepare for and respond to health emergencies. The workshop featured a mix of presentations, group exercises and breakout sessions based on experiences and lessons identified during the COVID-19 pandemic; it also included a dengue outbreak scenario. The workshop amplified global and regional initiatives to increase the use of social and behavioural sciences to inform RCCE, such as the utilization of data from the COVID-19 Perceptions and Behavioural Insights Survey and In-depth Interviews commissioned by the WHO Regional Office for the Western Pacific and application of data through the global WHO “Define, Diagnose, Design, Implement and Evaluate” (DDDIE) approach. It allowed participants to practise real-world and fictitious applications of social and behavioural science to RCCE intervention design. In the final session of the workshop, participants drafted a list of priority actions to promote the collection and application of social and behavioural insights in the context of emergency preparedness and response. This will be used to guide future work in this area. 5 1. INTRODUCTION 1.1 Meeting organization The workshop on Using Social and Behavioural Insights to Support Risk Communications in the Context of Emergencies in the Western Pacific Region was held in Manila, Philippines, from 11 to 12 April 2024. It was attended by 13 participants from seven Member States of the World Health Organization (WHO) Western Pacific Region: Cambodia, the Lao People’s Democratic Republic, Malaysia, Mongolia, Papua New Guinea, the Philippines and Viet Nam. Risk communication and community engagement (RCCE) focal points from WHO country offices also attended the workshop. The list of participants is available in Annex 1. The goal of the workshop was to build capacity in collecting and using behavioural insights to strengthen RCCE capacities. Member States presented on how social and behavioural insights had informed their COVID-19 responses. At the conclusion of the workshop a draft list of priority actions was produced for promoting integration of social and behavioural insights in the context of emergency preparedness and response to operationalize the Asia Pacific Health Security Action Framework (APHSAF). The programme of activities is available in Annex 2. 1.2 Meeting objectives The objectives of the meeting were: (1) to strengthen the use of social and behavioural insights in Member States by presenting and discussing the results of the COVID-19 Perceptions and Behavioural Insights Survey and In- depth Interviews; (2) to map challenges and opportunities related to the use of social and behavioural insights to inform risk communication activities and operationalization of C4H in the context of emergencies; and (3) to determine a draft list of priority actions for Member States to promote the collection and application of social and behavioural insights in the context of emergency preparedness and response. 2. PROCEEDINGS 2.1 Opening ceremony Mr Jan-Erik Larsen, Technical Officer, Operations Support and Logistics, WHO Health Emergencies Programme (WHE), provided opening remarks on behalf of Dr Babatunde Olowokure, Regional Emergency Director, WHE and Director, Division of Health Security and Emergencies, WHO Regional Office for the Western Pacific. A key message was to continue capitalizing on the momentum and capacity built during the COVID-19 pandemic for RCCE and the use of social and behavioural sciences. This work supports the overarching goal of being better prepared for and to respond to future emergencies. During emergencies, stand-alone information and public health recommendations are not enough to motivate communities and individuals to adopt protective behaviours. Effective communication requires the use of evidence − such as social and behavioural insights − to inform ways to communicate risk to different audiences and motivate people to act on public health advice. 6 2.2 Plenary 1: Overview of WHO’s work using behavioural science to strengthen preparedness and response to health emergencies The new global and regional frameworks and approaches for strengthening RCCE as part of health security were presented. This included leveraging the use of behavioural science for health impact. Presenters highlighted the need to strengthen community-centred approaches as part of building readiness and resilience for health emergencies. Presenters shared that RCCE rooted in the use of evidence operationalizes the Communication for Health (C4H) approach, which promotes evidence- informed, data-driven communication. It was highlighted that the use of evidence-informed practice is a key capacity of the RCCE competency framework and that using behavioural evidence is a key attribute across RCCE indicators utilized in the International Health Regulations (IHR) (2005) monitoring and evaluation framework. The session set the tone and context on the importance of scientific rigor and the need to understand and influence health behaviour in the context of emergencies. 2.3 Plenary 2: Introduction of principles for using evidence in health emergency preparedness and response and applying the “Define, Diagnose, Design, Implement and Evaluate” approach Participants were introduced to the “Define, Diagnose, Design, Implement and Evaluate” (DDDIE) approach, and a dengue outbreak scenario was used to explain its application. Participants were encouraged to share their personal experiences and reflect on how this approach would apply to national emergencies. This stimulated a robust exchange of experiences focused on the importance of understanding people’s behaviours to inform decision-making. Key session outcomes were that Member States strengthened their understanding of how to use the DDDIE approach for impactful RCCE. In the discussions, it was agreed that behavioural insights should derive from individual and community levels. Cultural context should be considered an important factor in the design of interventions at national and subnational levels. It was noted that there is a need to build capacity in (online) social listening and invest in data collection. 2.4 Plenary 3: Country presentations and discussions on behavioural insights to support risk communication Member State representatives shared presentations and discussed in plenary how they utilized behavioural insights to support RCCE during the COVID-19 pandemic. Findings from the COVID-19 Perceptions and Behavioural Insights Survey and In-depth Interviews commissioned by the WHO Regional Office for the Western Pacific were used. Key lessons shared were that effective health messages must address barriers to behaviour change that are specific to target audiences. It is important to engage trusted voices in communities as messengers to promote risk-reducing behaviours. Reliable information sources enhance public trust in health messages. A strengths, weaknesses, opportunities and threats (SWOT) analysis was conducted by participants to gain insights into the challenges and opportunities for the collection and use of social and behavioural evidence. Participants highlighted the strength of having access to data as collected through the COVID-19 Perceptions and Behavioural Insights Survey and In-depth Interviews to strengthen preparedness and response to emergencies. A weakness was considered the lack of time and limited capacity to conduct such research for future emergencies. A threat was the lack of sustainable funding and support for collecting behavioural insights. An opportunity was leveraging existing systems and structures that routinely collect health information and data. 2.5 Plenary 4: Collecting and using evidence for behavioural insights to inform effective risk communication and health emergency management This session made use of the dengue scenario introduced on Day 1, modified so that participants could practise skills focused on implementing and evaluating RCCE interventions. This included discussing 7 how to test messages before they are disseminated and the need to plan evaluation of activities before implementation, rather than after the intervention is completed. Participants recognized the importance of data collection and evaluation of activities, and also highlighted challenges regarding the rapid onset of emergencies and lack of resources. An opportunity to design data collection tools/protocols during the preparedness phase and leverage existing systems to collect data during the response phase of an emergency was spotlighted. For example, participants suggested incorporating knowledge, attitude and behaviour-related questions for at-risk groups during standardized national routine outbreak assessments. This could include understanding the level of trust in health authorities, the public’s preferred information sources or health-care-seeking behaviours. Some countries shared experiences regarding digital data collection, noting advantages for data collection and analysis. . Other key takeaways were to ensure the involvement of ethical review committees and to utilize different methods to collect data. 2.6 Plenary 5: Country planning and support for collecting and using behavioural insights for impactful risk communication and health emergency management During this session, participants identified priority actions to collect and utilize behavioural insights for impactful risk communication. These include: (1) Proactively identify opportunities to strengthen application of behavioural science theories and approaches to RCCE. Apply the DDDIE model to existing and upcoming activities and collect behavioural data through existing systems at national and subnational levels to ensure effective utilization of resources. (2) Step up advocacy to integrate behavioural approaches into RCCE and health emergency management. Fostering behavioural approaches underpins APHSAF and C4H implementation by being informed by data. Gaining leadership support is critical, which could include building an evidence base through strong measurement, evaluation and learning reporting. Championing a multisectoral approach is part of implementing APHSAF. (3) Include RCCE in budget lines by identifying existing or reserve funds for emergencies (for example, ministry or donor funds). Funding is required to design and utilize tools for sustained data collection and RCCE activities. (4) Strengthen capacity at national, subnational and local levels to collect and use behavioural insights. Strengthening capacity in this area enables evidence-informed intervention design and therefore better health outcomes. Strengthening country capability from the ground up is key to community-centred and localized interventions. (5) Translate existing tools, guides and training materials on behavioural theories and approaches into local languages. Translated resources are essential for localized intervention design. (6) Consider developing a community of practice with RCCE experts across the Region, including partners. The purpose is to have a platform or mechanism to reconvene and proactively share best practices and learnings of using behavioural insights to strengthen RCCE, including identifying synergies and collaborations, such as joint funding proposals. WHO can support Member States to implement these priority actions by: (1) Working with Member States to identify opportunities to strengthen integration of behavioural approaches to RCCE. For example, using existing social listening systems and engaging in message testing. This may also include opportunities identified during current emergencies, recommendations identified during assessments of IHR core capacities, and/or leveraging data collection mechanisms of other teams (for example, Emergency Medical 8 Teams or rapid response teams), stakeholders, organizations, partners (for example, research institutions) including the private sector. (2) Providing advocacy materials to obtain leadership support for behavioural approaches to strengthen RCCE and health emergency management. This could include utilizing the identified opportunities in priority action 1. Furthermore, planning and implementation of monitoring, evaluation and learning methods can provide an evidence base to underscore the use of behavioural approaches. (3) Working with Member States and across all levels of WHO to include RCCE and data collection into budget plans. This could involve provision of evidence-based rationale for donor funding to incentivize funding allocation to country level. (4) Utilizing the SWOT analysis report to inform development and implementation of a sustainable capacity-building plan to strengthen behavioural approaches in APHSAF implementation. This includes mapping and maximizing existing capabilities and resources (for example, emergency/field/technical teams beyond RCCE), followed by bridging capacity gaps. (5) Selecting key tools, guides and materials for translation and/or development, with a focus on localized/ground-level use. This would involve mapping existing emergency or disease- specific materials − including rapid assessments and tools − to identify gaps. (6) Working with Member States and partners to convene and co-develop the community of practice within 12 months of the workshop to review progress made on the priority actions. This may involve developing case studies and best practices in evidence-informed RCCE within the Region, as well as initiating the development of an implementation plan for the priority actions. 3. CONCLUSIONS AND RECOMMENDATIONS 3.1 Conclusions During the workshop, participants shared learnings and gained knowledge in behavioural theories and methods, namely through the methodology and findings of the COVID-19 Perceptions and Behavioural Insights Survey and In-depth Interviews and the DDDIE approach. Through the SWOT analysis and exchanges during the workshop, Member States were able to formulate their priority actions to advance the utilization of social and behavioural insights during emergencies. It was an opportunity for Member States to exchange experiences, which resulted in the request to form a community of practice. 3.2 Recommendations 3.2.1 Recommendations for Member States Member States are encouraged to consider the following: (1) Continue strengthening the use of behavioural evidence to inform interventions for current and future emergencies. (2) Address challenges of integrating behavioural approaches with other technical areas to inform RCCE activities as part of operationalizing APHSAF and C4H. 9 (3) Review and agree on the draft priority actions synthesized for Member States and WHO within four months of receiving the draft. 3.2.2 Recommendations for WHO WHO is requested to: (1) Support Member States to strengthen the use of behavioural evidence to inform interventions for current and future emergencies. (2) Support Member States to act on key opportunities identified for integrating behavioural approaches to inform risk communication activities, as part of operationalizing the C4H approach in the context of emergencies. (3) Support priority actions and capitalize on the momentum gathered. 10 ANNEX 1. LIST OF PARTICIPANTS PARTICIPANTS CAMBODIA Dr Srey TENG, Deputy Director, Communicable Disease Control Department, Ministry of Health, Phnom Penh, Cambodia. Mr Ouch RATANA, CDC Officer, Communicable Disease Control Department, Ministry of Health, Phnom Penh, Cambodia. LAO PEOPLE'S DEMOCRATIC REPUBLIC Mr Visith KHAMLUSA, Director, Center for Health Statistic and Information, Ministry of Health, Vientiane, Lao People's Democratic Republic. Ms Linda TIPHANGNA, Technical Officer, Center for Health Statistic and Information, Ministry of Health, Vientiane, Lao People's Democratic Republic. MALAYSIA Mr Wan Azrin Izani bin WAN MOHD ZAIN, Principal Assistant Director, Health Education Division, Ministry of Health, Putrajaya, Malaysia. Ms Gunasundari A/P MARIMUTHU, Senior Assistant Director, Institute for Health Behavioural Research, National Institute of Health, Shah Alam Selangor, Malaysia. MONGOLIA Dr Tuya BYAMBASUREN. Director, Division of Prevention Control and Coordination, Department of Public Health, Ministry of Health, Ulaanbaatar, Mongolia. Ms Gerelmaa SURENJAV, Director, Division of Health Promotion and Information, National Center for Public Health, Ministry of Health, Ulaanbaatar, Mongolia. PAPUA NEW GUINEA Dr Monica HAGALI, Chief Psychiatrist, Medical Standards Division, National Department of Health, Port Moresby, Papua New Guinea. Mr Judah IPARAM, Manager, Health Promotion, Public Health Division, National Department of Health, Port Moresby, Papua New Guinea. PHILIPPINES Dr Juan Javier F. GARCHITORENA, Medical Officer IV, Response Division, Health Emergency Management Bureau, Department of Health, Manila, Philippines. Mr Rhys Abraham S. YBIERNAS, Health Education and Promotion Officer III, Behavior Change and Social Mobilization Division, Manila, Philippines. 11 VIET NAM Mr VU Manh CUONG, Director, National Center for Health Communication and Education, Ministry of Health, Hanoi, Viet Nam. SECRETARIAT WHO Regional Office for the Western Pacific Mr Jan-Erik LARSEN, Technical Officer, Emergency Operations and Logistics, WHO Health Emergencies Programme, World Health Organization Regional Office for the Western Pacific, Manila, Philippines. Ms Lieke VISSER, Risk Communications (Responsible Officer), WHO Health Emergencies Programme, World Health Organization Regional Office for the Western Pacific, Manila, Philippines. Ms Anna BIERNAT, Communication Officer, Regional Director's Office, Regional Office for the Western Pacific, World Health Organization Regional Office for the Western Pacific, Manila, Philippines. Ms Ara JOHANNES, Communication Officer, Regional Director's Office, Regional Office for the Western Pacific, World Health Organization Regional Office for the Western Pacific, Manila, Philippines. Mr Ramy SROUR, Communications Officer, WHO Health Emergencies Programme, World Health Organization Regional Office for the Western Pacific, Manila, Philippines. Mr Trevor WEBB, Behavioural Insights Consultant, Office of the Regional Director, World Health Organization Regional Office for the Western Pacific, Manila, Philippines. Dr Nancy WONG, Risk Communications Consultant, WHO Health Emergencies Programme, World Health Organization Regional Office for the Western Pacific, Manila, Philippines. Ms Wenyajing ZHANG, Risk Communications Consultant World Health Organization Regional Office for the Western Pacific, Manila, Philippines. WHO Country Representative Offices Ms Lisa SMYTH, Technical Officer, Communication for Health (C4H), WHO Representative Office for Cambodia, No. 61-64, Preah Norodom Blvd. Sangkat Boeung Keng Kang I, Khan Chamkamorn, Phnom Penh, Cambodia. Ms Lenka DOJCANOVA, Risk Communications Officer, Pacific Health Security and Communicable Disease, Division of Pacific Technical Support and Office of the WHO Representative in the South Pacific, Suva, Fiji. Ms Rachel Manu LORIMER, Risk Communications Consultant, WHO Representative Office for Lao People's Democratic Republic, Vientiane, Lao People's Democratic Republic. Ms Liyann OOI, Behavioural Insights Consultant, WHO Representative Office for Malaysia, Brunei Darussalam and Singapore, Cyberjaya, Malaysia. 12 Ms Uran-ulzii MANDAKH, Team Associate, WHO Health Emergencies Programme, WHO Representative Office for Mongolia, Ulaanbaatar, Mongolia. Mr Willie LOVAI, Communications Officer, WHO Representative Office for Papua New Guinea, Port Moresby, Papua New Guinea. Ms Leovina RAMIREZ, Communication Associate, WHO Representative Office for the Philippines, Manila, Philippines. Dr Shane FAIRLIE, Technical Officer, Communication for Health (C4H), WHO Representative Office for Viet Nam, Hanoi, Viet Nam. WHO Headquarters Ms Elena ALTIERI, Unit Head, Behavioural Insights, Healthier Populations Division, World Health Organization, Geneva, Switzerland. Dr Nina GOBAT, Senior Technical Officer, Community Readiness and Resilience Unit, Country Readiness Strengthening Department, World Health Emergencies Program, World Health Organization, Geneva, Switzerland. Dr Karin STEIN IOST, Technical Officer, Behavioural Insights, Healthier Populations Division, World Health Organization, Geneva, Switzerland. 13 ANNEX 2. PROGRAMME OF ACTIVITIES Time Activities Speaker Day 1: Thursday, 11 April 2024 08:30 – 09:00 Registration 09:00 – 09:30 Opening Ceremony • Welcome • Opening remarks • Administrative announcements • Self-introductions of all participants • Overview of objectives and agenda Dr Nancy Wong, Risk Communication Consultant, WPRO Mr Jan-Erik Larsen, acting Regional Emergency Director, WPRO Dr Nancy Wong All participants Dr Nancy Wong 09:30 – 10:00 Plenary 1: Overview of WHO’s work on strengthening preparedness and response to health emergencies: • Global architecture • Asia Pacific Health Security Action Framework (APHSAF) and the Regional Action Framework on Communication for Health (RAF C4H) • Behavioural science for better health impact Dr Nina Gobat, Senior Technical Officer, Evidence and Analytics, Community Readiness and Resilience Unit, HQ Dr Nancy Wong Dr Elena Altieri, Unit Head of Behavioural Insights, HQ 10:00 – 10:15 Coffee break 14 10:15 – 12:15 Plenary 2: Introduction of principles for using evidence in health emergency preparedness and response and applying the “Define, Diagnose, Design, Implement and Evaluate” (DDDIE) approach. [skill building session] • Skill session 1: Define • Skill session 2: Diagnose Dr Elena Altieri Dr Karin Stein Iost, Technical Officer, Behavioural Insights, HQ Dr Nina Gobat All participants 12:15 – 13:15 Group photo, lunch break and mobility break 13:15 – 13:45 Plenary 2 (cont.): Introduction of principles for using evidence in health emergency preparedness and response and applying the “Define, Diagnose, Design, Implement and Evaluate” (DDDIE) approach. [skill building session] • Skill session 1: Define • Skill session 2: Diagnose Dr Elena Altieri Dr Karin Stein Iost Dr Nina Gobat All participants 13:45 – 15:30 Plenary 3: Country presentations and discussions on behavioural insights to support risk communication Moderator: Dr Nina Gobat Member States participating in WHO Regional Knowledge, Attitude and Behaviour surveys invited to present (Cambodia, Lao PDR, Malaysia, Mongolia, Papua New Guinea, the Philippines, Viet Nam) 15:30 – 15:45 Coffee/tea 15:45 – 17:00 Plenary 3 (cont.): Country presentations and discussions on behavioural insights to support risk communication [breakout session] Dr Nancy Wong All participants 17:00 – 19:00 Welcome reception Day 2: Friday, 12 April 2024 09:00 – 09:15 Recap Day 1 Administrative announcements Dr Nancy Wong 09:15 – 11:00 Plenary 4: Collecting and using evidence for behavioural insights to inform effective risk communication and health emergency management [skill building session] – Designing, implementing, and evaluating interventions of the “Define, Diagnose, Design, Implement and Evaluate” (DDDIE) approach: • Skill session 3: Design Dr Nina Gobat Dr Elena Altieri Dr Karin Stein Iost All participants 15 • Skill session 4: Implement Skill session 5: Evaluate 11:00 – 11:15 Coffee/tea and mobility break 11:15 – 12:00 Plenary 4 (cont.): Collecting and using evidence for behavioural insights to inform effective risk communication and health emergency management • Rapid tools and resources for emergencies Application of data Dr Nina Gobat Dr Elena Altieri Dr Karin Stein Iost All participants 12:00 – 13:00 Lunch break 13:00 – 15:30 Plenary 5. Country planning and support for collecting and using behavioural insights for impactful risk communication and health emergency management. Dr Nancy Wong All participants 15:30 – 15:45 Coffee/tea break 15:45 – 16:00 Conclusions • Recommendations Next steps Dr Nancy Wong 16:00 – 16:05 Closing ceremony Closing remarks Mr Jan-Erik Larsen www.wpro.who.int